Parents, purchasers, and other stakeholders lack information on the quality of the alcohol and other drug (AOD) treatment services typically available to adolescents. Outcomes-based performance measurement systems cannot yet identify effective programs, and few specific quality of care indicators have been identified for AOD treatment. Instead, state and federal officials encourage providers to adopt research-based treatments. Even this approach does not ensure quality improvement, however, because little is known about the effectiveness of research-based treatments when they are implemented in community-based programs. In this renewal application, we propose to develop quality of care indicators on which quality improvement systems for adolescent AOD treatment can be built. In support of this objective, SAMHSA's Center for Substance Abuse Treatment and its Office of Applied Studies will provide our team with access to a dataset of more than 15,000 adolescents assessed with a comprehensive interview at intake and 12-months later. SAMHSA will link these records to survey data on the organizational and facility characteristics of the more than 100 programs across the U.S. where the cases were treated. Using these extraordinary data resources and the causal modeling tools we have developed, we propose three new aims: (1) Test whether adoption of a widely disseminated research-based therapy (MET/CBT5) improves outcomes at community-based treatment programs; (2) Identify quality of care indicators associated with good client outcomes; and (3) Identify quality indicators for care provided to key client subgroups (e.g., clients with co-morbid psychiatric disorders). This renewal will allow our productive team, under the guidance of our longstanding advisory board, to continue to build the evidence base that effective quality improvement systems for adolescent AOD services will require. PUBLIC HEALTH RELEVANCE: The goal of this project is to develop quality of care indicators on which quality improvement systems for adolescent alcohol and other drug treatment can be built. To accomplish this objective, we will use a dataset of more than 15,000 adolescents assessed with a comprehensive interview at intake and 12-months later, which will be linked to survey data on the organizational and facility characteristics of the more than 100 programs across the U.S. where the cases were treated. By pursuing this research plan, we will address multiple research priorities identified by NIDA's Blue Ribbon Task Force on Health Services Research, including evaluating the effectiveness of interventions and practices in CBTP settings, establishing conditions for successful diffusion of innovations, and clarifying the influence of organizational factors on outcomes. [unreadable] [unreadable] [unreadable]